Provider Demographics
NPI:1598822892
Name:MCMINN, MARK R (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:R
Last Name:MCMINN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18703 NE WILLIAMSON RD
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-6778
Mailing Address - Country:US
Mailing Address - Phone:503-710-1433
Mailing Address - Fax:
Practice Address - Street 1:18703 NE WILLIAMSON RD
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-6778
Practice Address - Country:US
Practice Address - Phone:971-312-8453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2022-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1794103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical